| Name | Value |
|---|---|
| PROVIDER TYPE | Dental Providers |
| CLASSIFICATION | Dentist |
| DEFINITION | A dentist who has successfully completed an accredited postdoctoral anesthesiology residency training program for dentists of two or more years duration, in accord with Commission on Dental Accreditation's Standards for Dental Anesthesiology Residency Programs, and/or meets the eligibility requirements for examination by the American Dental Board of Anesthesiology. |
| AREA OF SPECIALIZATION | Dentist Anesthesiologist |
| STATUS | Active |
| VA CODE | V030490 |
| X12 CODE | 1223D0004X |
| SPECIALTY CODE | C5 |
| INDIVIDUAL/NON | INDIVIDUAL |
| MASTER ENTRY FOR VUID | YES |
| VUID | 5252474 |
| EFFECTIVE DATE/TIME |
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